Clinical Consultant I

Cotiviti

Clinical Consultant supporting Cotiviti’s healthcare clients with Coding Validation, claims policy review, and quality testing. Advising teams throughout implementations, go-live, appeals, and operations.

Posted 8/23/2026full-timeRemote • 🇺🇸 United StatesJuniorMid-Level💰 $80,000 - $95,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Coding Validation and clinical services, with a strong focus on client management and communication. Proficient in analyzing complex data and ensuring compliance with medical payment policies and CMS guidelines.

Highest-signal resume keywords

Registered Nursing License (RN)Professional Coder Certification (CPC, CPC-H, CPC-P, CCS-P, RHIT, RHIA)Coding Validation ExperienceClaims Adjudication ExperienceMicrosoft Office Suite Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Coding ValidationClaims AdjudicationMedical Payment PolicyData AnalysisMedical Terminology

Soft Skills

Strong Communication SkillsAnalytic Problem-SolvingClient ManagementAbility to Prioritize TasksCollaboration Skills

Tools & Technologies

Cotiviti SystemsNucleusJIRAMantisMicroStrategyTableau

Certifications & Qualifications

Registered Nursing License (RN)Professional Coder Certification (CPC, CPC-H, CPC-P, CCS-P, RHIT, RHIA)

Industry Keywords

Clinical ServicesHealthcare InsuranceCMS GuidelinesRegulatory ComplianceClient Relationships

Tech Stack

Tools & technologies

Tableau

About the role

Key responsibilities & impact

Support Clinical Services teams in validating quality and process consistency on the CPE editing engine
Provide Coding Validation subject matter expertise to clients and internal stakeholders throughout planning, implementation, go-live, transition to operations, and contract duration
Act as liaison for clinical information between internal partners and external customers
Facilitate client understanding of Coding Validation policies and concepts
Respond to client inquiries in compliance with policies and procedures
Review and analyze Coding Validation client inquiries and Change Requests
Assess impacts of decisions on affected policies and communicate with clients to clarify information
Provide resources for provider abrasion issues and Coding Validation quality issues
Explain Coding Validation coding concepts in writing and verbally
Communicate quality review results and revisions to clients
Develop action plans with the Quality Team to mitigate future issues
Collaborate with Client Teams to develop and maintain client relationships
Provide client-based input on edit configuration changes, rule updates, and new editing development
Assist Clinical Content Teams with client-perspective feedback on trends and new rules
Work with Quality, Training, and Operations Teams on review guideline updates, client-specific review changes, and client issues
Support Coding Validation implementations, including reviewing test claims and internal go-live support
Act as support liaison for the appeals management process
Support CPE Clinical Services quality assurance, including pre- and post-release testing
Assist with validation and review of client payment policies
Maintain Client Information Workbooks
Provide support during user acceptance testing in Nucleus

Requirements

What you’ll need

Associate or Bachelor’s degree in Nursing
Active and unrestricted Registered Nursing license (RN) in state of residence
Professional coder certification (CPC, CPC-H, CPC-P, or CCS-P), RHIT, or RHIA certification required
2+ years of clinical experience as a Registered Nurse
1+ years of experience in Coding Validation
1+ years of experience in coding including professional and outpatient facilities
1+ years of experience in claims adjudication, medical/payment policy, or utilization review working for a managed care or healthcare insurance company, or related experience
1+ years of experience in customer service or client management with a strong focus on healthcare setting
Ability to analyze complex data and synthesize it for customer and internal consumption
Strong research capabilities and knowledge of CMS guidelines, regulatory compliance guidelines and mandates, and medical payment policy
Proficient with Microsoft Office Suite (Word, Excel, PowerPoint)
Working knowledge of Cotiviti systems preferred
Demonstrates basic working knowledge of Nucleus, JIRA, Mantis, MicroStrategy, and Tableau within 90 days of hire
Knowledge of medical terminology
Effective analytic and problem-solving skills
Ability to handle multiple tasks, prioritize, and meet deadlines
Ability to properly handle confidential information
Ability to work independently and collaboratively in a fast-paced environment
Strong written and verbal communication and interpersonal skills
Ability to work with remote cross-functional product teams
Computer and technology literacy
Flexibility to participate in an international organization’s work processes and global-time-zone conference calls
After-hours and/or weekend work may be required for major deliverables/deadlines
Travel requirement up to 10%
Ability to provide a dedicated, secure work area
Ability to provide high-speed internet access/connectivity and office setup and maintenance
Ability to sit and use a computer keyboard for extended periods
Must be located in the continental US

Benefits

Comp & perks

Medical insurance
Dental insurance
Vision insurance
Disability insurance
Life insurance coverage
401(k) savings plan
Paid family leave
9 paid holidays per year
17–27 days of Paid Time Off (PTO) per year, depending on level and length of service
Remote work arrangement
Dedicated, secure work area and high-speed internet/office setup provided by the worker